**5. The role of lifestyle medicine in the management of diabetes mellitus**

All the components of lifestyle medicine are important and play necessary roles in the prevention of Type 2 Diabetes Mellitus and management of Type 1 & 2 Diabetes Mellitus. This is because Type 1 Diabetes Mellitus has a strong

**Figure 1.** *Courtesy American College of Lifestyle Medicine.*

relationship with genetics but lifestyle modification guides its management in the long-term to prevent diabetic complications such as diabetic neuropathy, retinopathy including diabetic foot ulcer. This is very important as it affects the overall wellbeing of the individual especially in developing countries where amputees are shamed and have general poor wellbeing and economic power. Type 2 Diabetes Mellitus can be prevented through modification in lifestyle by healthy living on a whole plant-based diet, prevention of obesity by weight control, having good sleep hygiene and avoiding unnecessary stress as much as possible [8, 12, 19]. This is because the risk factors of diabetes mellitus are related to modifiable lifestyle such as obesity [14]. The practice of lifestyle medicine is cost-effective in the management and prevention of diabetes mellitus because no special equipment is really necessary as what is involved is to be disciplined which has to be enforced by individuals on themselves [14]. Good healthy eating of a whole plant-based diet and increased physical activity is aimed at increasing energy uptake, reducing energy intake in food thereby preventing overweight and obesity which is a key risk factor for Type 2 Diabetes Mellitus and gestational diabetes mellitus [6]. Evidence from research has shown that remission of Type 2 Diabetes Mellitus with bariatric surgery can occur following intensive interventions in lifestyle but with few untoward adverse effects [11].

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participants [31].

**diabetes mellitus**

*The Role of Lifestyle Medicine in the Management of Diabetes Mellitus*

the optimal treatment of diabetes mellitus.

According to the American College of Lifestyle Medicine [11]:

1.Significant clinical improvement in patients with type 2 diabetes mellitus can occur following adequate intensive interventions in modifications of lifestyle.

2.Consumption of a whole plant-based diet in addition to participating in moderate exercise can lead to remission of diabetes mellitus and should be added to

Lifestyle modification is also important in the prevention of pre-diabetes Mellitus before it progresses to diabetes mellitus [3]. In the Heart of New Ulm (HONU) Project, the heart screening programme showed that a decline in lifestyle modification especially increased body weight (overweight and obesity) and consumption of alcohol as well as a reduction in the consumption of fruits and vegetables over two years is associated with a higher incidence of metabolic syndrome

The result of this project showed a strong association between body mass index and metabolic syndrome [11]. In another study conducted in Nepal, there was a statistical relationship between type 2 diabetes mellitus and hypertension, dyslipidaemia, alcohol and tobacco use [14]. All these are diseases related to harmful healthy habits which can be prevented by modification in lifestyle. Evidence from other research has shown that remission of type 2 diabetes mellitus is possible with non-pharmacological interventions which include lifestyle modification that translates to the practice of lifestyle medicine [8, 11], increasing physical activity in the form of exercise and engaging in healthy dietary habits and reduction in weight

Modification in lifestyle is the first line of management of diabetes mellitus. Weight loss is necessary for Type 2 Diabetes Mellitus and hypertension related to obesity. Exercise and healthy eating are necessary to lose weight and there are some of the pillars lifestyle medicine [29]. The reduction in weight is important as a preventive measure of cardiovascular disease and non-communicable disease as obesity serves as a risk factor for these diseases. The modification in lifestyle required for the management of diabetes mellitus are Medical Nutrition Therapy (MNT), Diabetes Self-Management Education and Support (DSMES), physical activity, cessation of the use of tobacco and counseling [30]. The results of the study conducted by Johansen et al. [31] in which 98 participants were randomized. There was a change in the level of glycosylated hemoglobin (HbA1c) from 6.65 to 6.34% in the group where there was an intervention in the modification of their lifestyle, there was a reduction in the dose of oral hypoglycaemic agents in 73.5% of the study

**6. The role of the pillars of lifestyle medicine in the management of** 

**6.1 The role of stress management in the management of diabetes mellitus**

Stress management is one of the pillars of lifestyle medicine. Stress can be defined as the response the body makes to any demand that is made on it. Being a diabetic is stressful already and diabetes mellitus is also stressful to the body; the worst is when there are diabetic complications. During stress, several hormones are released such as cortisol and other hormones that mobilized energy [32]. These hormones lead to hyperglycaemia as stress affects the endocrine system leading to

is the primary goal of prevention of Type 2 Diabetes Mellitus [11].

*DOI: http://dx.doi.org/10.5772/intechopen.99555*

including diabetes mellitus [11].

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

relationship with genetics but lifestyle modification guides its management in the long-term to prevent diabetic complications such as diabetic neuropathy, retinopathy including diabetic foot ulcer. This is very important as it affects the overall wellbeing of the individual especially in developing countries where amputees are shamed and have general poor wellbeing and economic power. Type 2 Diabetes Mellitus can be prevented through modification in lifestyle by healthy living on a whole plant-based diet, prevention of obesity by weight control, having good sleep hygiene and avoiding unnecessary stress as much as possible [8, 12, 19]. This is because the risk factors of diabetes mellitus are related to modifiable lifestyle such as obesity [14]. The practice of lifestyle medicine is cost-effective in the management and prevention of diabetes mellitus because no special equipment is really necessary as what is involved is to be disciplined which has to be enforced by individuals on themselves [14]. Good healthy eating of a whole plant-based diet and increased physical activity is aimed at increasing energy uptake, reducing energy intake in food thereby preventing overweight and obesity which is a key risk factor for Type 2 Diabetes Mellitus and gestational diabetes mellitus [6]. Evidence from research has shown that remission of Type 2 Diabetes Mellitus with bariatric surgery can occur following intensive interventions in lifestyle but with

**312**

**Figure 1.**

few untoward adverse effects [11].

*Courtesy American College of Lifestyle Medicine.*

According to the American College of Lifestyle Medicine [11]:


Lifestyle modification is also important in the prevention of pre-diabetes Mellitus before it progresses to diabetes mellitus [3]. In the Heart of New Ulm (HONU) Project, the heart screening programme showed that a decline in lifestyle modification especially increased body weight (overweight and obesity) and consumption of alcohol as well as a reduction in the consumption of fruits and vegetables over two years is associated with a higher incidence of metabolic syndrome including diabetes mellitus [11].

The result of this project showed a strong association between body mass index and metabolic syndrome [11]. In another study conducted in Nepal, there was a statistical relationship between type 2 diabetes mellitus and hypertension, dyslipidaemia, alcohol and tobacco use [14]. All these are diseases related to harmful healthy habits which can be prevented by modification in lifestyle. Evidence from other research has shown that remission of type 2 diabetes mellitus is possible with non-pharmacological interventions which include lifestyle modification that translates to the practice of lifestyle medicine [8, 11], increasing physical activity in the form of exercise and engaging in healthy dietary habits and reduction in weight is the primary goal of prevention of Type 2 Diabetes Mellitus [11].

Modification in lifestyle is the first line of management of diabetes mellitus. Weight loss is necessary for Type 2 Diabetes Mellitus and hypertension related to obesity. Exercise and healthy eating are necessary to lose weight and there are some of the pillars lifestyle medicine [29]. The reduction in weight is important as a preventive measure of cardiovascular disease and non-communicable disease as obesity serves as a risk factor for these diseases. The modification in lifestyle required for the management of diabetes mellitus are Medical Nutrition Therapy (MNT), Diabetes Self-Management Education and Support (DSMES), physical activity, cessation of the use of tobacco and counseling [30]. The results of the study conducted by Johansen et al. [31] in which 98 participants were randomized. There was a change in the level of glycosylated hemoglobin (HbA1c) from 6.65 to 6.34% in the group where there was an intervention in the modification of their lifestyle, there was a reduction in the dose of oral hypoglycaemic agents in 73.5% of the study participants [31].
